Editor’s note: This is the final part of four-part investigative series on Primary Healthcare by journalists in four newsrooms in Nigeria.
In this report, Olugbenga Adanikin, investigates how abandoned projects, fund diversion, cultural barrier worsen primary healthcare delivery in the north.
Kuraye is a rural community that is few kilometers off Katsina city. It is located in Charanchi Local Government near the state capital.
It is home to a large population of rural dwellers, mostly farmers and artisans. After spending over 45 minutes on hired motorcycle, scouting the village to locate the PHC, Lo and Behold! The only PHC in the community was an eyesore. The project was a constituency intervention built in 2010 but has never been put to use..
The PHC, investigations reveal, has always been under lock, and local groundnut farmers had taken over the compound and turned it into an assembling point for their farm harvest as they tiredly separate the groundnuts from the plant roots.
“This is a hospital built for lizards because there are no activities here. We address it like that because lizards, rodents have made it their abode,” Umar Bello, an adult in his early 30s said to this reporter upon request on operations of the facility, “hosipitu kadangaru,” he added in Hausa language.
From all indications, the hospital appeared inactive as it was under lock during the visit. There were no signs of power, neither was the water facility operational. It was already covered by weeds and lacked perimeter fencing.
In front of the facility was a traditional hand-powered borehole surrounded by children.
“The three staffs don’t come. There are few casual staffs so they don’t come as well because it is not mandatory for them to visit the PHC,” said Mallam Bashiru Al-sa’adu, another resident, adding that, “The State government supplies them with drug but it always get missing somehow.”
It is a worse scenario in Turaji and Tsageru, two neighbouring communities in Rimi Local Government of the state.
In 2013, under President Goodluck Jonathan, a lawmaker representing both communities in the constituency, through the National Primary Health Care Development Agency (NPHCDA) awarded a contract for the construction of a PHC in Turaji at the sum of N21 987 893,95.
Incidentally the construction firm, Greensols Energy Revolution Nigeria Limited, with Corporate Affairs Commission (CAC) registration number 805958, commenced work but did not complete the project till date. Residents attributed the non-completion to change of government but investigation revealed otherwise.
A visit to the contractor’s corporate address at House 13, Road 15, Efab Estate, Jabi, Abuja, revealed that the corporate address was merely a warehouse for a different organization involved in entertainments and corporate services.
A lady simply identified as Miss Chidinma said she had been managing the business for over five years on the same property. Asked if she knew the major shareholder, Mr. Anuwe Charles Olaosebikan, she said, “That name you called, I really don’t know anyone or company bearing that.”
From further investigations at the CAC, it was gathered that the firm was registered to execute jobs on renewable energy and had no relationship with construction of PHC projects.
“To carry on the trade of business as a renewable electrical company, consultants and installation, sales of solar products, wind- turbine and electrical appliances and services of any kind connected for the practice of renewable energy projects,” the company objective read.
Even though, the uncompleted project was not sited at the right location, both communities, Turaji and Tsagero had been subjected to seek medical help at the Rimi General hospital about three kilometers away from the Tsagero districts.
The general hospital is situated along Lambo rimi through Kano road. It was gathered that in extreme conditions, patients are taken to Katsina General Hospital, which is about 21 kilometres away from Tsagero and Turanji.
A source, who doesn’t want his name in print explained that the rimi general hospital has few doctors unlike the Katsina hospital, where there are many experts. “Before you enter rimi, you see the hospital. It’s about three kilometres from here.”
“We don’t know anything about it. The contractor just came and started building. We were not carried along but later we heard it is a PHC,” a group of youths who were obviously disgruntled told our reporter. They lamented over the abandoned project saying it should have been sited at Turaji but taken to the border point between the two communities to avoid conflicts.
Though, Tsageru community residents wanted the project constructed in their settlement but Abdullahi Umar, a resident, said Tsageru had an existing facility that was built by successive governments and later completed after years of neglect. However, it has never been equipped. (Picture of the Uncompleted PHC Project in Tsageru).
Located adjacent to the unequipped PHC in Tsageru lies a completed and fenced health centre but of no value to the people due to its emptiness.
It had neither furniture nor medical equipment. It was already covered with weeds like other similar projects while pests and other insects had taken refuge in the doors, gradually eating deep into it such that it could hardly serve its main purpose.
A school teacher living close to the facility, who pleaded anonymity, told this reporter that an Ex-lawmaker in the House of Representatives, Mohammed Dalhatu completed the project but did not equip it.
The local guard securing the abandoned PHC, Ayuba Majidi, who expressed concern over the gradual degeneration of the facility said the 2013 project was facilitated by former Senator Ibrahim Idah but remained uncompleted until interventions by successive governments. Majidi has been guarding the facility for over six years with irregular stipends of N5, 000.
Efforts to reach the lawmaker to enquire on reason for the delay were unsuccessful.
To Abdul-bashir Sa’adu, a farmer who grows groundnut, millet, sorghum and guinea-corn in one of the rural communities in Cheranchi, Katsina the NPHCDA could do more to ensure the PHCs are built to standard and functional as expected.
He appealed to the government to consider their needs and rescue them from the pathetic situation. To him, the future is not certain as most of their wives lack access to ante-natal care while the children suffer from tuberculosis.
“We want government to engage health practitioners that will be committed to delivering health service to our people. I mean those that won’t exploit the people and sell off the drug supplied.”
Obviously, these are the realities in major PHCs in the remote part of the country, especially in the north. The PHC projects are either not executed or built below standard, thus contributing adversely to healthcare delivery in the country.
For instance, in Kadasaka community, Gada local government of Sokoto state, the PHC project was no different from others. Already covered by bushes and suffered neglect, it was a complete rot and proof of government ineffectiveness in ensuring successful project standardization and delivery.
The project has been abandoned since 2009. The roof is almost completely blown away while the ceilings are falling off by the day. It showed that it was perhaps earlier roofed but got damaged due to either poor execution or harsh weather.
It was really a complete waste of asset and resources. While inspecting the abandoned project, one could see the large cracked walls, damaged hospital beds, cabinets as well as frames dented due to severe weather impacts.
Aside, there were also new delivery beds, still wrapped-up but wasting away, completely covered with dusts among other donated hospital equipment, all yearning for usage.
The experience of residents in Kadasaka community was pathetic. Hope of these underprivilege rural settlements seemed dashed as there are no signs of contractors return to the project.
Donated items by the United States Agency for International Development (USAID) including refrigerators, super industrial fans among others are wasting away in a leaking store already damaged by rainfall.
Health official, Nuru Abdullahi said they had to manage other facility and still take delivery of pregnant women in the small room directly at the frontage of the abandoned project. The dispensary is so small that it could hardly take a handful of people at a time.
Pregnant women from the 14 villages just like in Kalenjeni town, often make use of an extremely small room in the dispensary, sizeable enough to be a kitchen store for child delivery. The dispensary was constructed by the Sokoto state government and serves about 14 other rural communities.
Incidentally, the uncompleted PHC would have smoothly served over 600 people conveniently. In a chat with a health attendant in the dispensary, he narrated how they had to scout for water for delivery and medical use, saying in most cases they had to use donkeys to convey water from the nearest borehole which according to him, is miles away to the clinic.
“We need equipment and more staffs. We don’t have water at all. The borehole is no longer functioning. We used donkey to transport water from a far place to the centre,” he said.
Actually, this was a constituency project sponsored by former Senator Abubakar Umar Gada, who represented the constituency in 2009.
These are the challenges aside from other common problems such as inadequate staffs, insecurity, poor access to potable water and unstable medical doctors.
During the investigation, a visit to all the PHCs in selected states revealed inadequate health officers in the facilities. The least in the number of workforce is between two and five.
Unfortunately, the summation of these circumstances has threatened the nation’s health sector. The few functional ones have been overstretched to compliment the neglected projects which each PHC, according to Prof. Eyitayo Lambo ought to serve 70 per cent of rural communities it is situated.
For instance, in Garko local government of Kano State, Dal ward, a single PHC in Dal town serves about 42 villages because of its proximity to other neighbouring councils. These include areas such as Garko town, Sumaila and Tudunwada.
This PHC centre attends to approximately 40 patients daily and within nine months (January – August) took delivery of 92 pregnant women as at 25th August this year.
According to statistics made available by Gambo Edidal, the health official in-charge, 27 births were recorded in January, 13 in February, eight in March, seven in April, four in May, 10 in June, 10 in July and 13 in August.
Also, in Kalenjeni town, there are 14 villages only subjected to use four health dispensaries and not PHC centre. The only PHC that could have met health needs of the people remained under construction, thus abandoned. Unfortunately the officials were reluctant to disclose number of casualties.
Statistics of maternal deaths and infant mortality in the country is saddening.According to UNICEF, the North West is second highest in maternal mortality, recording 1,026 women from 100, 000 live births followed by the North East, having 1,549 deaths from 100, 000 live births.
“Every 10 minutes, one woman dies on account of pregnancy or childbirth in Nigeria, giving a total of 53,000 per year. This means about 800 women die in every 100,000 live births,” it stated.
In the latest report jointly released by the World Health Organisation, WHO, United Nation Population Fund, UNFPA, United Nations Children Fund (UNICEF) and World Bank this year, the nation recorded 58,000 deaths arising from complications during delivery in 2015.
In Sokoto state, health care delivery is considered to be on priority list of the government. The government successfully partnered with relevant local and international organisations to deliver effective health care to its people.
There were innovations specially tailored to reduce maternal mortality and other measures to encourage pregnant women attend Anti Natal Care (ANC).
First timers in the state would certainly presume a high standard of health care delivery because you are welcomed with bill boards of health programmes and partnerships with health bodies such as World Health Organization (WHO), Department for international Development (DFID), and National Primary Healthcare Development Agency (NPHCDA) to mention but few.
However, it appears the services are one sided mainly in the urban areas. A visit to remote parts of the state gave a contrary impression as constituency projects were largely abandoned or never executed.
In locations such as Kalenjeni Town, in Tangaza Local Government, among others were constituency projects that were uncompleted. In Dange Shuni town, Dange local government of the state, a constituency project worth N19 million awarded in 2009 could not be located, as it never existed.
Moreover, the only PHC according to health officials and volunteers was built in 2005 by the Sokoto State Primary Health Care Development Agency (SSPHCDA) as MDGs project. This position was also supported by Abubakar Mohammed, a volunteer PHC worker, who graduated from Sultan Abdulraheem College of Health Technology, Gwarabawa, Sokoto state.
Mohammed described how patients had to struggle to access health care in the community even at the General Hospital due to the distance. The community had reportedly lost high number of residents to untimely deaths.
“From 2015 till date, about 20-30 people have lost their lives due to lack of ambulance. It is a very serious problem”, he said, adding that, “we will be very happy if they can provide it for us.”
According to the workers, each time there is an emergency, they strived to rush victims to the hospital but often lose them due to the closing period of the general hospital. It allegedly closes at about 2pm daily and any emergency are not attended to.
“There is no other PHC aside from this one built in 2005 but rehabilitations have taken place since 2009, 2014.
Others are dispensaries. From Danbo to Damaki, there are no federal PHC,” He said, adding that “the closest general hospital is in Amanawa. They close 2 o’ clock, even if we refer patients there, they will not attend to them once its 2pm.”
The health workers asked for procurement of Ambulance to convey patients, to the Sokoto State Specialist Hospital, in the town, especially during emergencies. This is about 30-minute drive from Dange town.
In Kalenjeni Town, Tangaza, Shehu Umar a commercial motorcyclist serves as the health attendant in the oldest drug dispensary in the community among other three dispensaries serving over 10 communities in the area.
“Our pregnant women deliver here or we move them to Tangaza town in extreme situations. Since the project has not been completed, we want the government to expand and equip the dispensaries,” Umar pleaded.
The deplorable state of the PHCs has resulted into a number of deaths that are largely unreported. But investigations revealed that intervention projects by development partners, especially USAID saved not less than 6,313 women and new babies between 2010 to 2015.
But the traditional ruler, Majagi Yahaya claimed there have never been casualties. But in order to salvage the situation, lawmaker representing the constituency, Hon. Isah Bashir Kalenjeni facilitated, in 2012, the construction of Type II PHC project.
It was awarded at the sum of N33 million and expected to serve all the communities far away from the General Hospital.
However, five years down the lane, the project is still uncompleted. The project contractor, Umairatu Nigeria Consults Limited only built the hospital up to the lintel level and left.
During a visit to the contractor’s registered office in 106B, Old Airport Quarters, Minna, Niger State, the major shareholder Muhammed Abdullahi Muye, was inaccessible to explain reasons the project became moribund.
The registered corporate address was now occupied by the Niger State Supply Company Limited. Residents in the quarter claimed ignorant of the Umairatu Consults stressing that the only organization recognized with the above address belongs to the State government.
The firm has no company secretary registered in the CAC document and there was no indication of a change of company address.
The security personnel, who directed this reporter to other senior staff in the organization, to ascertain authenticity of the company claimed ignorant of the firm. Other residents could also not locate the firm.
After much efforts, this reporter could not locate the contractor’s address.
“I am not sure there is any company bearing that name. In fact this is my first time Walahi,” a worker in the state supply company added.
Even though core area of this firm’s activities include the business of poultry, animal husbandry, fish farming and agricultural farming in its entire ramification including food production and distribution, it also embark on haulage and transportation business and by extension, “business of general contractor on any building and construction including buying and selling of building and construction material.”
It appears to lack the right experience in project construction relating to health care delivery.
The project management consultant at B&B Partnership, Flat 8, NSITF estate, Abuja, could not also be reached. The project was also supervised by Nasraj Integrated Services Limited, Abuja.
Tired of poor performance and limited capacity of the dispensaries, Kalenjeni traditional ruler, Majagi Yahaya appealed to relevant individuals while tasking the federal government to rescue the community from the situation.
Even though, he denied there were cases of child or maternal mortality since inception of the community, it was gathered that three drug dispensaries in the community were not fully functional while the general hospital is far away from the people.
“In Kalenjeni there are four dispensaries and the most functional is the newly rehabilitated one built in the town. But they are all small. Our women have their antenatal in these dispensaries and give birth in the recently repaired facility but we want bigger PHCs that will cater for our people.”
When this reporter visited the NASS official website to get the lawmaker’s contact(he was a legislator from 2007-2015), it was discovered that Bashir Kalenjeni had omitted his mobile contact as well as his email. So he could not be reached.
The situation was not different in PHC, Gada town, Gada Local Government. Gada is a stone’s throw to Niger Republic.
The PHC project was a N19.6 million scheme but left uncompleted. According to Ashimu Musa, Kydawa-Kalaba community leader, accessing good health care had been a serious challenge. But the residents were fortunate that a small dispensary built in 1991 by Taminu Galadima, a former chairman of the local government and a serving member of the state House of Assembly is still functional. It is a distance of 20 meters opposite the abandoned project.
Bashir Umar, one of the residents, who is a pastoralist described the project completion as vital to the locals. Beside the forgotten facility was another abandoned water project. Umar said pregnant women do more of home delivery. (Picture of the abandoned PHC in Kyadawa, Gada)
When Hon. Musa Serikin Adar, the House of Representative member from the constituency was contacted, he said he was not in office. All efforts to contact him outside the NASS building were unsuccessful. He was not also responding to messages sent thereafter.
In Sumaila local government, Kano state, the situation is not different. The project was built but unused due to poor execution.
When the reporter visited the facility, a health official, who sought anonymity, was busy attending to a pregnant women, and other women who brought their children for healthcare sat under a tree within the compound the facility was built on.
Upon request, the official opened the facility which appeared large enough to address the health needs of the people. However the PVC ceiling had fallen off. The entire facility was covered with dust and remains from termite infestation on the woods. The toilet facility was no exception as well as hospital beds.
However, the N18.9 million (2007) PHC project in Dal town, Garko local government of the state relatively met needs of the rural dwellers. It only opens for 12 hours due to security reason and within this period, it is expected to serve villagers from over 42 settlements.
Though, it is short of staff, especially medical doctors but the dental optician often come to the rescue when need be. “We do get drug through the Drug Revolving Fund (DRF), from the state central medical store but we need nurses and midwives.
“Because our PHC is close to the boundary of Garko, Sumaila, Tudunwada, all the people around use the clinic,” says Mallam Gambo Edidal, Director of the PHC. Other challenges identified by him is the leaking roof, damaged door, need for ambulance and general renovation. (Picture of Ambulance in Dal, Garko LGA, Kano).
Kaduna State has about 5,854 villages and 390 districts. In Zaria local government, two PHC projects in Zaria Dutsen (N18.98 million) and Zaria Damari (N18.90 million) could not be located. All efforts to locate them were fruitless. Available information also showed that there was no place called Zamari under the local government.
Representative of the traditional ruler, Zaria Dutsen Abba, who is addressed as the Chief of Staff, Abdulmumin Abubakar was glad to join this reporter in the search for the projects awarded in 2007 to Mantleview Interbiz.limited at the sum of N18.98 million and Toddlers Nigeria limited respectively.
Abubakar denied knowledge of such PHC constituency project built in 2007 in his community except for another built by a different contractor in 2009.
He further said he had never heard of Zaria Damari. He went as far as consulting other elders in the community to inquire but no one had knowledge of such constituency projects.
But just opposite the chief’s house is a PHC built by the state government and was under reconstruction as at the time of visit. It was said to be serving about 15 villages and used to provide immunization to the wards.
Having searched in vain for the location of the project, the Deputy Director, Zaria Local Government Health Authority, Aliyu Ibrahim Abdul was contacted to assist with both projects locations.
According to him, there is only one PHC constituency project in the area, which is the one in Kugu aside from the Leprosy Specialist Hospital. However, he was quick to say there was no place called Damari in the local government.
Though he noted that some of the facilities are often rehabilitated and may not necessarily have the same structure as at the period it was built.
“Different NGOs do come to repair the PHCs. Even the chair you are sitting upon is not provided by the state or federal government but different NGOs. So that facility you mentioned is the one built by the federal government. The second one is located in Kugu, Kaura ward and Dutsen Zamari is not in Zaria local government.”
However, with CAC registered number 484405, Mantleview Interbiz.limited, which only has two directors, has no company secretary.
It was not also licensed for project construction, especially relating to health facility but to “carry on the business of trading, sales, marketing, distribution of general goods be they manufactured or not, commission agents, manufacturer’s representatives, importers, exporters, general suppliers, general contractors, general merchants, to buy, sell, manufacture and deal in all articles, substances, products, systems and appliances.”
Effort to locate the registered corporate address at 16A Uyo Street, Area 2, Garki II was unsuccessful. The address did not exist. The search was also extended to Oyo street, perhaps the Uyo was a typographic error for Oyo, but only 17 and 19 exist and not 16A. Ex-Senator, Dalhatu Seriki Tafida was not also reachable for reaction.
Implications of absence of PHCs in rural communities
At the moment, Nigeria bears witness to some of the worst healthcare data in the world and often found close to the bottom of virtually every development index. In February 2017, the World Health Organization ranked the Nigerian health system in 187th place out of 190 countries evaluated.
Although, recent report from the United Nations Development Programme (UNDP) says life expectancy has increased to 53 years but remain lower than many poorer African countries.
Malaria kills more Nigerians than any other disease, and yet barely one-twentieth of its population has access to insecticide treated nets proven to be effective in preventing malaria.
Added to this is the appalling statistics where one in every 30 Nigerian women die from child birth every year compared with one in every 30,000 in Sweden. Nigeria currently accounts for a quarter of the total number of deaths of children under five.
This implies that from 5.3 million children born in the country annually, one million of these children die before the 5th year birthday. For Nigeria to witness better Health System Ranking there is need for government to spend more than the present five percent of its public expenditure on health.
However, the meager amount made available to the sector does not make appreciable impact as most of the funds are either diverted or mismanaged by corrupt politicians and highly connected top government officials. In worse scenarios, the approved budget is not totally released to the ministry for implementation.
For instance, in 2014, about 6 per cent representing N262 billion was allocated for health but 82 per cent of the money went for recurrent expenditure.
In 2015, the sector got N237 billion. As for 2016, stakeholders in the sector had expected about N900 billion for the sector but it got only N221.7 billion from N6.08 trillion total budget.
This was far below the World Health Organisation (WHO) recommendation that government should spend N6, 908 per head on health care for their citizens. The global body recommended at least 13 per cent of annual budget to the health sector.
In 2017, stakeholders appealed for 6 per cent allocation to the sector but eventually, the sector got budgetary allocation of N304,190, 961, 403 representing only 4.17 per cent. In other words, a meagre sum of N1, 688 is being spent on each of the about 180 million Nigerians for the year.
A number of African countries such as Rwanda, Botswana, Malawi, Zambia even Burkina Faso reportedly set aside double digit allocations to their health sectors.
Incidentally, Nigeria in 2001 signed an Abuja declaration where it was agreed by African Union (AU) member countries that 15 per cent of their annual budgets should be dedicated to the health sector but 16 years after, it’s still a mirage.
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